Provider Demographics
NPI:1336455856
Name:JOHNSON, WENDY SIBREY (PHARMD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:SIBREY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 W BRANDON BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4808
Mailing Address - Country:US
Mailing Address - Phone:813-685-0871
Mailing Address - Fax:813-655-3864
Practice Address - Street 1:1602 W BRANDON BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4808
Practice Address - Country:US
Practice Address - Phone:813-685-0871
Practice Address - Fax:813-655-3864
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-21
Last Update Date:2010-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS27788183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist